No Margin, No Mission: The Business Truth Healthcare Leaders Must Accept | Amy Hay (Part 1/4)

Intro - 00:00:06: Welcome to the Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, serial entrepreneurs, and experienced investors about the challenges and triumphs of running a biotech startup from pre-seed to IPO with your host, Jon Chee.

Our guest today is Amy Hay, Chief Business Officer at CTMC, a joint venture between MD Anderson Cancer Center and National Resilience, accelerating cell therapy development from discovery to clinical translation. At CTMC, Amy leads business strategy, helping early-stage biotech companies navigate the complex journey from preclinical research to commercialization by providing end-to-end manufacturing, regulatory expertise, and clinical access all under one roof.

Before joining CTMC, Amy served as Global Head of Oncology Strategic Initiatives at Varian, a Siemens Healthineers company, where she launched Oncology as a Service, a global platform integrating medical technology, clinical solutions, and digital services to expand access to advanced cancer care. Under her leadership, Varian forged partnerships with Ayala Health in the Philippines and CHRISTUS Health in the US, generating more than $75,000,000 in new revenue within the program's first year.

Amy is also a founder, having founded Evolve International, a healthcare strategy firm advising leading cancer organizations across academic medicine, medtech, pharma, and digital health. With a Master's in Healthcare Administration and over twenty-five years of experience spanning MD Anderson, proton therapy development, and global oncology strategy, Amy's career demonstrates how resilience, curiosity, and strategic partnerships can accelerate the future of cancer care, making this a conversation you won't want to miss.

Over the next four episodes, Amy shares how her grandparents influenced an early passion for helping people through crisis and how her father's advice to "behave as if you're in your next job" carried her from college in Texas through MD Anderson and around the globe to build partnerships that democratize access to advanced cancer care. She reflects on lessons from starting as a receptionist and patient advocate, raising $125,000,000 to launch MD Anderson's Proton Therapy Center in the wake of 9/11, building the MD Anderson Cancer Network across multiple continents, and learning that you can't just "plug and play" solutions across cultures from Brazil to Nigeria to the Philippines.

She also unpacks founding and selling her own consulting firm right before the pandemic, navigating the integration of Varian and Siemens, and why bringing manufacturing, regulatory, and clinical expertise together at CTMC can derisk and accelerate cell therapy development for biotechs of all sizes.

Today, we'll hear about Amy's early days growing up in Dallas, the influence of her artist mother and business-minded father, and how caring for her grandparents through dementia shaped her passion for supporting people through crisis. We'll also hear how she approached college with a photo essay documenting individuals at a Dallas food bank on Thanksgiving, her internship as a child life specialist at Santa Rosa Hospital, and why she realized she wanted to be part of healthcare, not just as a clinician. Lastly, we'll hear about her first day at MD Anderson Cancer Center in 1996 and how starting as a receptionist taught her to never say no—only how.

Without further ado, let's dive into part one of our conversation with Amy Hay.

Jon Chee - 00:04:37: Amy, it's so good to see you again. Thanks for coming on the podcast.

Amy Hay - 00:04:40: Great to see you as well. Thank you, Jon, and I'm excited to have this time with you today.

Jon Chee - 00:04:44: Yeah. And thanks for being so generous with your time. I know you're very busy, so making time—I'm really grateful for that. Really, we've been looking forward to this. I know we've kind of had this on the calendar for a while now, but a place we'd like to start—and we always think it's fun—is to really turn back the hands of time and learn a little bit about you personally and just how you found the initial inspiration to do what you do. So take us all the way back. What was your upbringing like? What formed your leadership style and science and business philosophy?

Amy Hay - 00:05:13: Thank you for asking the question. And it's always fun to kind of go back in time. I'll try not to rewrite history to make it sound more exciting, but I've always been very passionate about people and helping people. As a child, I had a very early introduction to healthcare and to medicine through our extended family. Watching my dad's parents suffer from dementia and watching my parents take care of them and try to nurture them through that... very early on, I wasn't sure what I wanted to do, but I knew it had to do with providing some sort of assistance to people as they were going through crisis.

Sometimes I tease about the comment of "never let a good crisis go to waste" because on the business side, that's absolutely the case. But I think that's also the case on the life side, right? It's very easy to get bogged down into the negativity of a crisis when I think that what we should be doing is focusing on how we're going to grow from that crisis in the long term.

So as I was growing up, I was very blessed in that I have two wonderful parents who are best friends and twins in a way, and I have a sister, but I also had my grandparents very much involved in my life. Very different, I think, than most families in today's environment. I didn't have babysitters. I had my grandparents who lived down the street. And I was very fortunate to have that because I think that it's really instilled in me this confidence of being able to do anything I wanted.

I was always taught, "If you work hard and you try hard, you'll get there. It might take a long time. It might be a little bit bloody, and you might be battered, but you'll get to the top of the mountain. You just have to work hard." Even in my very first job, which was straight out of college—kind of almost a receptionist position at a hospital—I did just that. I was very unhappy because I thought, "You know, I just spent all this time in college, and I studied hard. And now I'm answering telephones, and I'm checking in patients at the front desk."

And my father called me and said, "You know what you need to do? You need to behave in a way that is your next job. Pretend like this isn't your job today. Behave in a way that is your next job." And I've done that, I think, very successfully over a very long career. I've focused. I've never said no. I've only said how. And I think that serves me well, and I only hope that I instill that in my own kids along the way.

Jon Chee - 00:08:08: I love that. And I was having a conversation with a colleague of mine too who said something similar. It's almost like you're pulling forward the future when you do that. He works at a venture firm, and in investing, there's kind of a hierarchy to things and what you're allowed to do at any point in time. But he was just like, "I'm just going to teach myself and just do that next step now and just try to be good at that as best I can and just create this momentum." And it doesn't have to be venture investment; it could be anything, really. So I love that. That's an awesome perspective on where you're at now and where you can be in the future.

And I had a similar experience. I was raised by my parents, but also my grandparents as well. Part of my early experiences was taking care of my grandmother during dialysis, and that was the same thing. I was like, "I want to be in caring for people broadly in healthcare and life science, especially during crisis when people need it the most." It's kind of been seared into me. So I really empathize with that. And while you were growing up, from your family unit, were they like, "Hey, you gotta be studying these things," or this or that, or was it a much more freewheeling environment?

Amy Hay - 00:09:23: Yeah, it was much more freewheeling, but it's interesting because I do think that, in fact, actually very much formed me. My mother is an artist. I will tell you right now, I can't draw a stick horse. And for years, I thought, "This is so unfair. I have a mother who's an artist who creates things and uses her hands." My father was in the business world. So for most of my early childhood, I couldn't identify with that artist side of my mom. I could only identify with my father on the business side. So that's the direction that I started heading.

The interesting part of it is that now what I realize is I had that artistic side the whole time. My artistic side comes in a different form. My artistic side is being able to put two things together that shouldn't go together and make it a 10. My artistic side is how to create new, novel business structures or how to create new collaborations that others maybe would never consider. So I do think there's an art to that. And while I didn't appreciate it when I was younger, I was surrounded by this artistic spirit of creation and then this business side. And I think I got kind of the best of both and melded it together.

Jon Chee - 00:10:48: I feel the same way in that I wasn't kind of stereotypically creative. Like, I am a big music fan—I listen to a lot of music—but I cannot make music. But I definitely see opportunities outside of your kind of stereotypical artistic realm where you can express that creativity, and it manifests and comes about in a bunch of different ways. So I love that. And as you were approaching thinking about going to college, where were you thinking of going? What were you thinking of studying? Take us back to where your mind was at at that phase.

Amy Hay - 00:11:22: Yeah. It was really interesting, and I also think it's fascinating when I talk to early adults now and hear about their college journey and the process because it was completely different. And anyone that's in that fifty-year-old age group will identify with me. There were two colleges I wanted to go to. One was in Puget Sound, and I'd never been there, but it looked gorgeous. And it was a small liberal arts school. And, of course, my parents were thinking, "Why do you want to go there again?" Most likely because it was pretty and far away.

The other was Southwestern University in Georgetown, Texas. Again, small liberal arts, but three hours from home—you know, I grew up in Dallas. I ended up going to Southwestern. And the ironic part of it is that, unlike today, I didn't apply to a hundred schools. There was no electronic portal. Back then, there was a big envelope, and you wrote it out. And if you were lucky, you had a microprocessor that you typed your application on.

One of the benefits of Southwestern is they allowed me to not write a personal essay but to do a photo essay. And at the time, I was very interested in photography, and that was kind of my mechanism in high school to try to have some creativity and hone in on it. So for my application to Southwestern—and I hope my mom still has it, but that's a good question for her next time—I did a photo essay on the food bank in Dallas, Texas on Thanksgiving morning.

I went down there and volunteered, and I took pictures of all these people. But I didn't just take pictures of these people; I visited with them. So I went over, and I talked to them, and I asked them their name and where they were from and "what brought you here today?" and "what's your story?" And I then at the end said, "Would you mind if I take a photograph of you?" And I compiled these pictures, and it was almost like a photographic journey of individuals that were finding themselves on Thanksgiving Day with all their belongings that they had in the world, getting a free lunch and chatting with a sixteen or seventeen-year-old kid from the right side of town who was generally and genuinely interested. Like, I wanted to know how did you end up here, and what's next? Like, what do you want to do, and how can the infrastructure here help?

So it was kind of a pivotal moment for me looking back on it because I, again, was drawing on the art side, but then I was connecting with the people. So it wasn't just about the photograph. You know, anybody could take a nice black-and-white photograph that's pretty, but it was about what was behind the photograph. So that led me into Southwestern. Thankfully, they saw some opportunity in me.

And as I went into my college years, it's a liberal arts facility. It's wonderful, small, and I focused on really all of the liberal arts side—psychology, history, sociology, philosophy—and just kind of surrounded myself with that. I ended up graduating with a major in psychology, minors in education and history, but it never really took me away from the person, the individual, the caring, the wanting to connect with another human. And while it's taken different formats over the years, that's kind of always been the underlying premise.

I think one other thing I would share is that my final semester at Southwestern, I actually did an internship at Santa Rosa Hospital in San Antonio. It was a child life internship. And for those of you that are listening that maybe aren't as familiar, child life specialists are individuals with psychiatry/psychology backgrounds who work with kids in the hospital—whether it's on trying to cope with disease or the process or the treatment. I got very focused on that, and it was really an opportunity to see how you could play different roles in healthcare, not just be a clinician or a nurse—which are unbelievably valuable and those are tremendous people—but I knew I wasn't cut out for that. It needed to have another angle to it. So that's really how I left college—with that experience of being in a hospital, helping people, recognizing that I probably wasn't the right one to deliver the treatment, but I wanted to be part of it. And then steering myself toward how to do that in a really meaningful way that I felt good about.

Jon Chee - 00:16:25: I love that. And I agree that healthcare broadly speaking, the most famous roles are kind of doctors and nurses. But if you want to play a part, we need all the help we can get. And everyone has something to contribute regardless of what your domain specialty or interests are. You will probably find an opportunity in healthcare broadly where you can provide value. I felt the same thing. I gave it a shot. I was like, "I'm gonna try to be a doctor." I was like, "Oh. I don't got what it takes." And that's okay, and that's totally okay. At least it's beneficial to learn that early because that journey can be so, so long. I have friends who are now practicing physicians, and they talk about it. They're like, "Yeah. Even during the whole phase of training, when you actually go practice, it's also vastly different than what you were training for." So it's holy moly. Like, this could be an eight-year journey where you'll never know. But during your undergrad, were you doing any extracurriculars that you were involved with? And were there any professors that perhaps took you under their wing or maybe gave you some inspiration?

Amy Hay - 00:17:40: Honestly, college, I'm very fortunate. College was just kind of this magical time. I ended up meeting my husband on the first day of college, so that was kind of the start of my personal journey. In addition to that, I was really active on campus. Part of us were already part of different clubs and that sort of thing. And I do think that's, in my opinion, part of the really magical part of a liberal arts education as well. Yes, oftentimes, my parents kind of looked at me over the holidays and said, "Now what again are you gonna do when you get out?" But I came out of it with so much value across the entire spectrum that then allowed me to choose my path.

I did have quite a few really incredible professors. Southwestern is one of those small liberal arts colleges where your classes are small enough that if you don't show up, your professor might stop by your dorm and knock on the door. So it's a very different environment, you know, and that just creates these very close relationships. In the psychology department, I had several mentors, one on the experimental side, Dr. Purdy, who had a whole lab full of cuttlefish. To this day, I'm still allergic to cuttlefish.

Jon Chee - 00:19:00: Yeah. Yeah. Yeah.

Amy Hay - 00:19:02: Versus incredible professors who focused their whole attention on the Vietnam War. I took more classes in history, not because it was supposed to be my minor, but because it was just fascinating. And to look at these people who devoted their whole life to really key points in history and educating the next generation of that, I think that is just an invaluable service to the rest of us. I mean, there's a reason why we often fail when we don't recognize that we're repeating history, and that's more relevant today than it's ever been.

Jon Chee - 00:19:42: Absolutely. Yeah. And we have short-term memory as people, so it's always important to be a student of history if we want to continue to progress, or we'd just be stuck in this infinite loop. And so it sounds like you had a wonderful experience in your undergraduate. As you're approaching graduation, you mentioned your kind of first role. Did you know what was next for you as you were approaching?

Amy Hay - 00:20:05: Absolutely not.

Jon Chee - 00:20:07: Yeah. Yeah. Yeah.

Amy Hay - 00:20:08: So my senior year in college, my husband, Colin Hay, he was a year ahead of me. So my senior year in college, as I was about to go off to do my residency at Santa Rosa for child life, we got engaged. And he was a year ahead, so he was already in Houston and had a job. So teasingly, I said to him, "When I graduate, I'm not coming to Houston of all places unless I'm engaged, so forget it. I'm going back to Dallas." And I think that perhaps accelerated our engagement. And so got engaged. I had to eat my words and move to Houston when I graduated. And I was really in a position of "what do I do next?"

I mean, there was no... at that point and especially from where I was, I hadn't really gotten that far ahead. My next stop was Houston because I was getting engaged. That was it. And once I got to Houston, I needed to find a job because I needed to pay the rent. So as I mentioned before, my first job was actually at MD Anderson Cancer Center, and that was in 1996. And I will never forget the day because it was the same day that Dr. John Mendelsohn started his presidency.

So during that day, of course, I was brand new. I was a child, and I was trying to engage in the workforce. He was the president of the organization on his first day. We didn't really get to know each other until years and years later. But I told him this story that I remember sitting in the audience—and it was, I think, Hickey Auditorium—and listening to him and his vision for the organization. I was just in awe listening to this man who was a scientist and a researcher and a physician. He'd already held a life where he saved people's lives. He created new drugs. I mean, he had done things that I couldn't even wrap my head around. And it was his first day, and it was my first day. Completely different universe.

And over time, I think that was kind of defining for me because it made me realize that today is the first day of the rest of my life. Right? It can be what I make of it. It can be something incredible and great, and I can be so proud of it, or it could be mediocre. And that's up to me. That's on me. And it really did lead me to these next steps.

I stayed in that position for about a year realizing, okay, I'm gonna learn everything I can. I'm gonna learn all of the IT infrastructure. I'm gonna learn every system. I can still tell you if you order a CT, you need a button in Korean. I tried to just suck in knowledge. And over time, the doctors and the nurses and the staff came to me for everything because they knew that I would never say no. They knew I would just figure it out. I would say yes even if I had no idea what the word meant, and I would go figure it out. And it's that type of resilience that I think really helped me over the years in my career even when things were bad, even when I had some tough calls or a bad break. It's that resilience that kind of keeps you going.

So as I went through that first year, I immediately, as soon as I could, looked for the next position. And I took a position at MD Anderson as a patient advocate, which, again, went back to my roots. This is a group of people at Anderson who work in the clinics. They're there to support the patients. If you have a problem or a need or are struggling, how can we help you? Our job is to help you.

So during that transition, I got the opportunity to really learn the clinical side—everything from how the clinics operate, how patients go to surgery, how patients get blood draws and chemotherapy—not only from the patient's perspective but also from the physicians' and the nurses' perspective. Right? Because at the end of the day, we're all human. We might be helping these patients with cancer that they're fighting today, but we're all fighting something, whether it's our health, whether it is a problem at home. I mean, there's always something. That's just the way the world revolves. So I think I brought a different approach.

At the same time, I also realized that there's the business of healthcare here. It would be lovely to think that you can get the best healthcare no matter what ZIP code you live in and no matter where in the world you live, and that's just not a reality. We had a CFO at the time that used to always say "no margin, no mission," which seems a little bit painful, but it's kinda true. You have to have that business acumen to be able to really be visionary and provide new treatments and provide better care. And so there is a symbiotic relationship to the business of healthcare and to the delivery and quality of healthcare. So it was at that juncture that I thought, "You know what? I think I would probably benefit from getting a Master's in Healthcare Administration" and took that next leap educationally.

Jon Chee - 00:25:34: Cool. Yeah. I was gonna say, just the earliest experience at MD Anderson of always saying yes to opportunities and then getting the reputation... they're like, "Oh, Amy's gonna help. Like, I need help. I'm just gonna tap Amy's shoulder." And I think that is such an underrated way to just make yourself invaluable in any organization. Like, it really could be anything. Just be having the willingness to roll up your sleeves and not turn your nose up to whatever thing it might be. And I've seen in my career as well... it's just like, it's kinda the same thing as being willing to take out the proverbial garbage or fold the laundry. It will earn you a lot of cred internally with any organization. So I love that.

And, also, I think the CFO's comment about "we gotta make this make business sense too." It's like when it does make business sense, it's almost like an accelerant to the innovation. There's plenty of stuff when we think about academic research... there's like no margin kind of incentive there because it's academia, and there's a place for that. But on the other side, when you can make the business economics work for everybody, it just kind of gets the machine going and really up to scale. Because I think sometimes what I've noticed too is sometimes the transition from academia into the business side... things get lost in translation because there's no requirement while you're in academia for that. And then you can kind of go down a road where it doesn't make economic sense for a really long time, and then you're like, "Oh, crap. Like, we need to figure out the economic side of this quick." And sometimes you never figure it out. And then if you could have a general understanding upfront of what it takes to make something make economic sense, it'll save you a bunch of heartache later down the road.

Amy Hay - 00:27:26: Exactly. This isn't even specific to any one organization, but one of the things over time that I think I've learned is that in these incredible institutions of research, the research teams think that they define the organization because of their research. The clinical patient delivery side thinks they define the organization. They're both right because they need each other to exist. Right? And so it's that bridge that I think is key here, you know, and it's not just key in delivery of cancer care. It's really key in manufacturing. It's key in the biomed business. It's the connective tissue that is required to make both the research and the delivery successful.

Jon Chee - 00:28:15: Yep. Absolutely. And I think I used to be kind of in one of the fiefdoms of research. And early days, I was like, "This is all that matters." You believe your domain is the only thing. It's the end-all, be-all, but it really is exactly what you said—the connective tissue that matters and bridging that gap and reconciling the differences in approach where you find the magic. Because I've seen on the polar opposite ends of the extreme, when one rules, it has a whole host of problems on either end. So it's kind of this thing where you need to be able to toggle it for magic to happen. So you've gotten this kind of early exposure, and you're like, "There's something here that I need to kinda double click on and explore more and go back to school." Can you talk a little bit about your kind of grad school experience, and how was that for you?

Amy Hay - 00:29:01: So I think I did it a little bit the hard way, but, honestly, I think it was probably the most valuable. I went to Houston Baptist in Houston, and I picked that program specifically because it was in Houston. And two, it was a Monday through Thursday, six to 9 PM at night program. So it allowed me to work all day and then go to school, but not have to give up the weekends at least, but pretty much be, you know, work to school four days a week. It was pretty grueling for about two years, and I think my husband didn't see me for about two years.

And on the other hand, what it afforded me was that I was getting day-to-day practical experience. And so I was in a program where I had people right out of college. I had people like me. I had doctors who were going back and getting a Master's in Healthcare Administration. And I found it just really insightful and more valuable because I was learning about things that I could apply real-time. It wasn't hypothetical. It wasn't just a book. It was me being able to say, "Okay, I understand that macroeconomic theory, and here's how I could apply that to diagnostic imaging." And it was real, right? And so one of the things that I often tell people that are trying to figure out their paths is give yourself a little bit of grace to have some experiences in the workforce. And it doesn't matter if that is answering a phone or if that's in commercial or waiting tables. Give yourself that experience because I guarantee you, it will be valuable in applying knowledge as you move forward.

Jon Chee - 00:30:48: Absolutely. And when I was younger, the early roles I had were in retail and kind of hospitality. And at that point in time, I was like, "These skills aren't additive." That was way back when, but now I look back on it, and I'm like, "Oh, man, was it additive." How to handle when a customer's mad and yelling at you? I was working a cash register at a deli, and just, like, how do you handle an upset person? With keeping your cool as possible and be as diplomatic as possible—that's a skill that you can take anywhere. Insane theme. Just being in hospitality is just how do you make people feel comfortable and taken care of is, again, a transferable skill even if you're outside of that industry. So I totally agree with giving yourself some grace to experience it all. And that schedule sounds intense, but like...

Amy Hay - 00:31:39: It's kind of intense, but it paid off. I will say it definitely paid off.

Outro - 00:31:45: That's all for this episode of the Biotech Startups Podcast featuring Amy Hay. Join us next time for part two where Amy recounts her path from patient advocate to administrative fellow, how she differentiated herself by understanding every touchpoint of patient experience, and why empathy for clinical staff became her secret weapon. She also shares how she landed a role with the radiation oncology team, what it took to open MD Anderson's first satellite clinic in Bellaire against internal skepticism, and how that experiment shaped the entire MD Anderson network strategy that followed.

If you enjoy the show, subscribe, leave a review, or share it with a friend. Thanks for listening, and see you next time. The Biotech Startups Podcast is produced by Excedr. Don't want to miss an episode? Search for the Biotech Startups Podcast wherever you get your podcasts and click subscribe. Excedr provides research labs with equipment leases on founder-friendly terms to support the path to exceptional outcomes. To learn more, visit our website, www.excedr.com. On behalf of the team here at Excedr, thanks for listening.

The Biotech Startups Podcast provides general insights into the life science sector through the experiences of its guests. The use of information on this podcast or materials linked from the podcast is at the user's own risk. The views expressed by the participants are their own and are not the views of Excedr or sponsors. No reference to any product, service, or company in the podcast is an endorsement by Excedr or its guests.

‍